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Intubation

Intubation is the insertion of a breathing tube or artificial airway (endotracheal tube - ETT) into the trachea via the mouth. On occasion the tube may be inserted through the nose down into the trachea.

A patient will require intubation when they are unable to breath for themselves. This may be as a result of a disease process or certain mrdications such as anaesthetic drugs. Once intubated, a patient will usually be attached to a breathing machine (ventilator). Together this equipment will take over some or all of the work of breathing until the patient is able to do this for themselves.

The patient is laid down with a bedside monitor attached to continually assess vital functions. Intravenous cannulae are required for the administration of the drugs and fluids.

The patient is given an anaesthetic to put them to sleep. A laryngoscope is used to open the mouth up, see down the throat and pass the ETT through the mouth and into the trachea. The cuff of the ETT is blown up using the pilot tube. This creates a seal around the tube within the trachea. The correct position is checked in several different ways and then the tube is anchored to the patient using adhesive tape or a plastic device.

The patient will then be attached to a ventilator to assist with breathing. A chest X-ray is usually performed to confirm placement.

Once a patient is intubated, they may be given a continuous infusion of a sedative drug so that they can tolerate the tube. The patient will be unable to talk because the ETT prevents the passage of air through the vocal cords. Under rare circumstances, a patient will be intubated because they have an obstruction in their airway such as swelling or infection. It may not be necessary for these patients to bee attached to a ventilator. Once the patientís condition allows, the tube will be removed (extubation).

The most common complication is the incorrect placement of the airway tube. This will be apparent through assessment of the patient's vital signs. These problems are evident very quickly and there are a number of checks, which are undertaken by the clinician after intubation, to ensure correct placement.

ET tube in situ, ready for bag attachment..
Laryngoscope used to guide ET tube..


Laryngoscope used to guide ET tube..


Vocal cords

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